Mapping the policy landscape of school nurse practice laws in the United States

BACKGROUND: State-level regulations governing school nursing licensure, certification, and employment vary widely across the United States, creating inconsistencies in minimum practice qualifications and implications for student health and workforce stability. PURPOSE: To systematically map U.S. school nursing practice laws and assess the strength of regulatory environments. METHODS: Using a systematic, web-based search and abstraction tool, we collected data on four domains: school nurse title protection, requirements to be called a school nurse, mandated employment, and certification/endorsement availability. A composite policy score (0-4) quantified regulatory strength. DISCUSSION: Most states protected the school nurse title (41+DC) and had minimum requirements (39+DC), though qualifications varied substantially. Twenty states mandated school nurse employment, and 27 offered certification/endorsement. States with strongest policies were concentrated in the Northeast and Midwest. CONCLUSION: Findings reveal a fragmented policy landscape with substantial opportunities to standardize educational/licensure requirements, strengthen employment mandates, and support a qualified school nursing workforce.